Nonoperative detorsion can often be effective for sigmoid volvulus, but some patients clearly need emergency surgery.

• 44.9% of patients required emergency surgery; previous volvulus history and shorter symptom duration were significant.
• Relative indicators for surgery include vomiting and hypokinetic bowel sounds; gangrenous stool and rebound tenderness are absolute indicators.

Surgeons should evaluate these clinical features to guide timely decision-making in patient management.

• Rates of shock (1.3% vs. 22.2%) and hyperkinetic bowel sounds (35.3% vs. 20.1%) further distinguish nonoperative from emergency cases.